04100186 C ITY.OF',CUPERTINO 4^s (�'�v� pe�d'�xw ,_"
BUILDING DIVISION PERMIT
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BmLDmcADOREss: CAL-WEST ROOFING CO. PERMITNO.
OWNER'S NAME: - - PERMIT ISSUE DATE'
z ADAM. _ . N
- SANITARY OL NO..
ONE: . .. . - '
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT .. PLUMB—_ MECH. ..
0 0 0
.�00 LICENSED CONTRACT'OR'S DECLARATION ,.IObDeeCllptlOn
Oit -' 1 hereby a(firmthnI 1 am licensed under provisions of Chapur 9(commencing. - - -
< with srmmn]0007of0ivtvon 3 of the Business and Profamiom Code,and my license is
<�
in fall forces deffect. ARCIIIIE
REROOF NI -
5 = LimnaeClaaa ueb' �SHINGL
Dsm g5 ECS- INALED
¢¢ 1 understand my plans shall a used as public records
a� Licensed ProfessionalDEC I's2004 .
OWNER-BUILDER DECLARATION
I hereby.fano that 11. exempt from the Contractors License Law for the -
p o following requires
mason.Permian 8131.5,Business and Pm,therms Code:Any city nr county
x o which mqulrm a permit ns cnnsvece epee impmve,demolish,or repair any structure
prior kr its lssmnec.am requires(be applicant rorsuch permit to ale a signed statement
that he is licensed pursuant mthe provisions ofthe CmarromesLicenseLaw(Chapter 9 SLI.Ft.Floor Valva oq,
as❑.� (commencing with Section 7")of Division 3 of the Business and Professions Code)or ,
3 Nor he is exempt therefrom and On basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 691b MAir,10 0 Occupancy Type
not more Nen Eve hundred dollars(5500).
❑1,as ownerofthe property;or my employees with wages as their aole re-Pematlon. -
willdothavok.and Ne structure ismalmorded oroffered hosed.(Sec.7054,Business _ - p.
Required Inspections - -
and Professions Cade:The Connector'License Law does not apply m an Owner of 9
' pmperty who builds or improvm thereon,andwho doessuchworkhimselforthrough hisown employees,provided thmsuch improvementsam not imernl dOro@red forsala IL
however,the building or improvement Is mid within one year of compleuon.the Owner.
builder will have Ne burden of proving Out he did not build or improve for purpose of
vale,).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-. -
- came Law does not apply to an owner of property who builds at improves thereon,and,
- who contracts for such projects with a contractor(s)licensed pursuant in the Convector's -+—`-•"—"-" "'_'- "'-""--'--�—V.
License Lxw, - -
❑I am exempt under Sec, .B&P-C fm this mason _ .. . ... -. ..
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of the following declarations:
I hers and will maintain a Ceniftc.te of Consent to self-inmre for Worker's Compen- _
cation,as provided for by Section 37M of the Labor Code,for the performance of the
work for which Nis permit is issued. _
❑I have and will maintain Workers Compensation Insurmce,as required by Section
37W of the Labor Code,for the performance of the work for which this Pettit is issued.
My Workers Compensation Insurance envier and Policy number me: -
CartierPoll NO.: ... . . .
C RTI^ TE OF 9EMMON FROM 0 KW R ERS' .
COMPENSATION INSURANCE
(This section need notbecompletad time Permit Is fora..hundreddmIsrs(SIM) -or less.)
I cenify Not in the performance Of the work for which this permit is issued.I shall net
employ any person in any manner so ss to become subject to the Worken'Compenalmn
Laws of California.Data -
ApplicantNOTICE TO APPLICANT:If,after tusking this Ccnifrcam of Exemption,you should
become subject in the Workers Compensation previsions of the Labor Code,you must
�Z forthwith comply with such previsions or this permit shall be deemed revoked.
OCONSTRUCTION LENDING AGENCY
I hereby xlnmt Nat there is acensvuctinn lending agency In,Ne Nurormmec of
!Yi r7 the work for which this Permit is issued(Sec.3097,CO.C.)
W�Q Lenders Nunn -
.7,z lender's Address
U 0 1 certify Nat 1 have read this application and sten that the above information is
LL F toren.l agree to comply with all city and county ordinances and state laws relating to -
0 U building construction.and hereby suthmim repmummives of this city to enter upon the
above-mentioned property for inspection purposes.
gym (We)agree to save,indemnify and keep harmless the City Of Cupcnino against
rq liabilities,judgments,costs and expenses which may in any way scout against mid City
U Z in ccmu fume.of the granting of this permit.
^rt APPLICANT UNDENO WILL COMPLY WITH ALL NON-POINT Issued by: Date eq
SOURCREGULAT S.
n ,� ,I C e IP4 AP!/ Re-roofs
signmum of phcmvcontmnor of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant atom orhandie hamrdous mammal
as defined by the Cupertino Municipal Code.Chapter 9.17,and the Health and Safely
Code,Seen..25537(a)l All roofs shall be inspected prior to any roofing material being installed.
El yes .e+�
Will the applicant or future building Occupant tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mil tenuous air comm ommas as defined by the Bay Area Air Quality Mmagro nl all new materials for inspection.
District?
�Yca
I have read the hamNOus materials mquiromrnts under Chapwr6.95 of the Califor- '
nice Health&Sdcty Codd,Sectirm 255115,8533 and 8534.1 understood thmifthc building
docs not currently hast a tenant,Nat it is my rcapomibility m muly the occupant of the CJ S/�-Q �A✓
mom nes ormissumceofaCertificate ofOccupancy. Signa ure of Applicant Dat/
U 6� Y r°/2AIO'1 All roof coverings to be Class"B"or better
Owncr or mmflrcd agent
Community Development
' 10300 Torre Avenue
Cupertino'CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Bu- ildin Department
JOB ADDRESS: PERMIT#
vs 0. O / oo /86
OWNER'S NAME: ; PHONE #
GENERAL CONTRACT FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature D to
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
SUPEkTINO
CITY OF Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3'. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3). Final inspection approval
a) Spark arrester installation. .,
. 5. If plywood is installed,a plywood nail inspection is required.
6. 'Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed. .
IMPORTANT:
1. Flat roofs must have a minimum of V4" per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O.report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name:
Job Site Address: 2,0.
Roofing Company Name: .. Ca//asci � w
A 11�plicant's Signature: Jr-- Date:
\N
Greg eel
Building Official
Revised 1/30/03 -
. - Printed on Recycled Paper
CITY OF CUPERTINO
5TV0F
REROOFsk
CUPERTINO PERMIT APPLICATION FORM
APN# D / (� Date: O
(J 2
Building Address:
s t.r.� 95•>,i
Owner's Name: Phone#:
53/ / G/
Contractor: Phone#: License #:
3 3G
Contact: d Phone#: Cupertino usmess License#:
0 36Y-288 6 � D
Type of Roof Covering:
f ,
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles _;a---.ACsphaf Shingles
' ❑ .Wood Shakes ❑ Wood Shakes °
❑ Wood Shingles -_- - ❑ Wood Shingles
Id' Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide LC.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read;.Understand and Will Comply With Cu ertino's Tear Off Polic : fr
Job Description: A
Residential Commercial ❑ a
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if ty
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group: -
19 SOo=
Qty. if
Applicable Fee ID Fee Description Fee Group '
J BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING,
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK . Plan Check Fee BUILDING
BUSLIC Business License BUILDING
27S! r